sentations: P2

P2-351 LUNGURRANGOORA: A PILOTMODELOF CARE

Poster PreP384

FOR AGED AND DISABLED IN A REMOTE

AUSTRALIAN ABORIGINAL COMMUNITY—CAN

IT WORK?

Dina Logiudice1, Kate Smith2, David Atkinson3, Emily Carroll4,

Frank Schaper5, Geraldine Shadforth2, Rhonda Murphy6,

Nicola Lautenschlager7, Leon Flicker8, 1Melbourne Health, Melbourne,

Australia; 2WACHA, Perth, Australia; 3KAMSC, Broome, Australia;4WACHA, Perth, Australia; 5Alzheimer’s Australia, Perth, Australia;6Yarmintali Consultancy, Perth, Australia; 7University of Melbourne, Kew,

Australia; 8WACHA, Perth, Western Australia, Australia.

Background: The literature on the health of, and services for, older Ab-

original and Torres Strait Islander populations is relatively sparse. This

study explored the development and implementation of a locally de-

signed community service model of care for older people, people with

disability and/or mental health problems in remote Aboriginal Australia.

Methods: Based on extensive community consultation with older people,

families, carers, community members and stakeholders, a model of care

was developed to address unmet needs for the target population and their

carers in the remote community of Looma, Kimberley. The model was im-

plemented and evaluated over 12 months. The main outcome measures in-

cluded the number of services (including home services, meals, transport,

respite, personal care and advocacy) provided. Outcomes of community

participation, capacity building, resources, partnerships, workforce, ser-

vice delivery and cultural protection were assessed qualitatively by an ex-

ternal evaluator.Results: The number of people receiving community care

services in Looma increased from 8 to 22, and services increased in all do-

mains from 140 total services delivered for one month at baseline to a total

of 2395 by the final month of the program. Home services included clean-

ing, laundry, shopping, yard maintenance and social support. Respite in-

cluded fishing, camping, art activities, hunting, BBQ picnic and others.

Advocacy included initiating and ensuring completion (including provi-

sion of equipment and maintenance of equipment) of all types of services

for clients, and also liaison between services. Staff education totalled 29

training sessions, including 5 completing Aged care certificate 3 part 1

courses, mental health first aid and dehydration training. 6 people were

employed within the community. Conclusions: The Lungoora Ngoora

community care service model pilot project demonstrated a successful col-

laborative service model that addressed the care needs of the older person,

and those with disability and mental illness, and their carers in the remote

community of Looma, Kimberley. The developmental approach, and

model structure, could serve as a template for future delivery of services

in remote Aboriginal communities.

P2-352 IMPLEMENTATION OF PERSONALIZED,

EVIDENCE-BASED MOUTH CARE FOR PERSONS

WITH COGNITIVE OR PHYSICAL IMPAIRMENT:

MOUTH CARE WITHOUTA BATTLE

Sheryl Zimmerman, Lauren Cohen, Ann Louise Barrick, Philip Sloane,

University of North Carolina at Chapel Hill, Chapel Hill, North Carolina,

United States.

Background: Older adults with cognitive or physical impairment who rely

on others for help with daily care often receive inadequate mouth care. Rea-

sons for deficient care include lack of training regarding how to properly

provide care and how to handle behavioral challenges. Unfortunately, the

absence of such care results in adverse health outcomes, including inflam-

mation, infection, pain, pneumonia, and malnutrition. While evidence-

based techniques to provide mouth care to these persons exist, none have

been organized into a program that can be replicated by others across set-

tings ranging from private residences to nursing homes. This project devel-

oped such a program, entitled Mouth Care Without a Battle�, and evaluated

the feasibility of its use in three nursing homes. Methods: Mouth Care

Without a Battle was developed by an interdisciplinary team of experts

who critically reviewed evidence regarding best practices in oral hygiene

care and working with older adults with cognitive or physical impairment.

Mouth Care Without a Battle provides techniques related to both optimal

oral hygiene practices as well as working with persons with dementia.

This presentation will report on how certified nursing assistants were trained

as oral care aides to implement Mouth Care Without a Battle, and how this

training not only changed perceptions and knowledge of mouth care, but

also care practices. Results: Six oral care aides in three nursing homes

were trained to provide personalized daily mouth care to 97 persons of vary-

ing self-care abilities and resistance to care. During the eight week program,

the aides successfully provided care to 95 (98%) of these individuals, on

81% of the days attempted. On average, 76% of indicated care (brushing,

interdental cleaning, fluoride application, denture care) were consistently

provided. Oral care aides reported greater knowledge about and self-efficacy

to complete mouth care after training (P ¼ 0.034) and indicated that they

had not realized what they did not know about daily mouth care before par-

ticipating in the program (P ¼ .06). Conclusions: Daily mouth care can be

successfully provided for persons with cognitive or physical impairment,

but training is required because the related techniques are not a component

of standard care.

P2-353 THE VIVALDI METHOD AND THE SUCCESSFUL

CARE OFALZHEIMER’S PATIENTS

Daniel Boucher, Vivaldi Residences, Oka, Quebec, Canada.

Background:An experimental care unit for Alzheimer patients introduc-

ing the combination of four fundamental elements individually and pos-

itively recognised by the scientific and medical community: (1)

a specific, balanced and personalized diet; (2) adequate control and ad-

ministration of medication; (3) support for proper sleep; and (4) specific

and personalized physical stimulation. To this frame is added a specific

method in the interraction of the patients with various technical care pro-

viders and withthe disposition of the physical environment (configuration

of spaces, accessories, methods of providing care, etc.). The Vivaldi Ap-

proach has been fashioned from working with and treating Alzheimer’s

patients since 2005 in the environment where the pilot project was cre-

ated and grew, namely: The Vivaldi Residence in Oka, Quebec, Canada.

A completed work was registered in June 2011 at the (C.I.P.O.) Canadian

Intellectual Property Office (Copyright 1087800) under the unpublished

book entitled “The Vivaldi Moment”. Methods: To validate the incidence

of the most favorable living conditions through the evolution and control

of the disease, criteria and informative scales to analyze the various patient

states were established and effective tools of evaluation and documenta-

tion to specify the needs of each patient were developed. The goal is to

favor cognitive expression (re-establish connections or slowdown the

loss of functions) through the means of establishing cognitive, sensory

and emotional pointers. Results: A series of objective evaluative tools

and procedures were discovered to analyse the impact of the “life frame”

on the evolution of the disease. A caregiver’s guide with specific protocols

and approaches to use along with each patient’s care plan was developed.

Conclusions: From the documented stage of the disease (regression, sta-

bilisation, augmentation of symptoms) through the use of the analytical

tools created, it was determined that the specific “life frame” offered by

the Vivaldi Method increases the quality of life of residents. A residential

concept with a home-like environment system and precise physical char-

acteristics was conceived and developed for people affected by Alzheim-

er’s disease.

P2-354 RACIALVARIATIONS IN MEDICATION USE

AMONG DEMENTIA PATIENTS

Gail Rattinger, Mehmet Burcu, Sarah Dutcher, Ilene Zuckerman,

Pankdeep Chhabra, Linda Simoni-Wastila, Christine Franey,

Loreen Walker, University of Maryland Baltimore SOP, Baltimore,

Maryland, United States.

Background: Our objective was to assess population-based medication

utilization and variations in drug use by race and care setting among

Medicare beneficiaries with Alzheimer’s disease and Related Disorders

(ADRD). Methods: In a one-year (2008) cross-sectional study, we identi-

fied 52,754 ADRD patients from a 5% random sample of Medicare

Poster Presentations: P2 P385

beneficiaries to estimate annual prevalence of the following drug classes:

cognitive-enhancers (acetylcholinesterase inhibitors or memantine), anti-

depressants, antipsychotics, and mood-stabilizers (valproic acid, carbama-

zepine, oxcarbazepine). Regression models were used to report

black:white, Hispanic:white, and other:white (Asian, Native American,

missing) relative prevalences (RP) of ADRD medication use, adjusted

for age, sex, low-income subsidy and long-term nursing home (LTNH) sta-

tus (LTNH-none, LTNH-some, LTNH-full). We tested for a raceLTNH-

status interaction. Results: Patients were predominantly female (79%),

aged > ¼ 75 (87%) and had >1 comorbid condition (52%). Annual

drug class prevalence was 9% mood-stabilizers; 34% antipsychotics;

56% antidepressants; 57% cognitive-enhancers. Most were white

(83%), 12% were black, 3% were Hispanic and 3% were other.

LTNH-status distribution was 41% LTNH-none, 42% LTNH-some and

16% LTNH-full. LTNH modified the effect of race on drug use for anti-

depressants and cognitive-enhancers (both p<0.0001). Compared to

whites, blacks were the least likely to use antidepressants, and this dis-

parity was greatest among LTNH-none (adjusted-RP LTNH-none 0.55;

LTNH-some 0.70; LTNH-full 0.75). Cognitive-enhancer use for LTNH-

none and LTNH-full was lower among blacks versus whites (adjusted-

RP LTNH-none 0.92; adjusted-RP LTNH-full 0.92; adjusted-RP

LTNH-some 1.02). For antipsychotics and mood-stabilizers, raceLTNH-

status interaction was not significant. Blacks and other races were less

likely than whites to use antipsychotics (adjusted-RP-blacks 0.90;

adjusted-RP-other-races 0.84, P <0.01). Compared to whites, mood-

stabilizer use was lower among blacks and other races; (adjusted-RP-blacks

0.88; adjusted-RP-other 0.82, P <0.01). No significant differences in drug

prevalence were observed for Hispanics versus whites. Conclusions:

Blacks and other races were less likely to use any of the four classes of

medications compared to whites for ADRD management. LTNH status

modified this relationship for antidepressants and cognitive-enhancers.

Race differences in medication utilization and modification of this rela-

tionship by LTNH status suggest variations in treatment used to manage

ADRD symptoms regardless of changes in ADRD care setting.

P2-355 “SPECAL” SENSE: A POSITIVE DEVIANCE

APPROACH TO DEMENTIA CARE

Margo Karsten, Creative Health Care Management, Windsor, Colorado,

United States.

Background: Over the past decade multiple therapies have contributed

to assisting in the care of dementia. Currently, validation, resolution

and reminiscence therapies or a combination are in place in various set-

tings. However, the evidence for the specific efficacy of the therapies has

not been fully researched. Methods: One method in the United Kingdom

appears to have been researched and the efficacy has been demonstrated.

SPECAL “Specialized Early Care for Alzheimer’s” has been in place for

over twenty years. Prichard and Dewing (1999) completed a multi

method evaluation of the SPECAL method. The initial study identified

that there was a lower level of stress experienced by the caregiver and

increased wellbeing for the client with dementia. This case study took

the tools that were implemented in the initial study and replicated the

SPECAL approach for one client. A biographical data sheet was com-

pleted, as well as a SPECAL observational tracking tool, to identify fre-

quently asked questions and answers that kept the client in a calm state

of wellbeing. Lastly, following three interventions (not asking questions,

treating the client as the expert and never contradicting, through obser-

vations methods), the client’s behavior and activity level was monitored.

Results: Over a period of one year, there was a noticeable improvement

in the client’s wellbeing. When SPECAL methods were applied, the cli-

ent eagerly went outside her home, did not ask repetitive questions, and

her overall wellbeing improved. She continues to live at home with

a main care giver, and is not on any type of psychotropic medications.

Conclusions: Further study is needed to replicate the original study of

Pritchard and Dewing (1999). However, this case study identifies the

efficacy of the SPECAL method and the ability to improve the client’s

wellbeing when the tools are consistently applied to the home setting.

P2-356 VERBALMEMORY PERFORMANCE IN HEALTHY

OLDER ADULTS: PREDICTING INTER-

INDIVIDUAL DIFFERENCES IN COGNITIVE

TRAINING OUTCOMES

Anna Wolf1, Rapson Gomez2, Mathew Summers3, Jeffery Summers2,1University of Tasmania, Hobart, Tasmania, Australia; 2University of

Tasmania, Hobart, Australia; 3University of Tasmania &Wicking Dementia

Research and Education Centre, Launceston, Tasmania, Australia.

Background: There is a paucity of research investigating the characteristics

of individuals who best benefit longer-term from training interventions tar-

geting age-related cognitive decline. Latent growth mixture modeling

(LGMM) can be used to identify classes of individual with different trajec-

tories of cognitive decline. The present study used LGMM to identify clas-

ses reflecting trajectories of decline for verbal memory across a 12- month

period, following participation in a cognitive training program. It also exam-

ined how these trajectories were predicted by age and education.Methods:

A total of 253 community dwelling older adults (age M ¼ 66.82, SD ¼7.1yrs) participated in a 10-week group, multi-dimensional cognitive train-

ing program: the Active Cognitive Enhancement (ACE) program. The Rey

Auditory Verbal Learning Test (RAVLT) was used to measure verbal mem-

ory and learning performance. Testing was conducted prior to and repeated

immediately following the program, and at 6- and 12- month follow-ups. A

no-contact control group (n ¼ 62; age M ¼ 65.76, SD ¼ 7.2yrs) was also

assessed across the same time intervals. Results: The findings in LCMM

analysis supported three classes: high, medium and low- memory perfor-

mance. T raining induced the biggest gains in the group with the low- per-

formance memory class. Years of education and age did not appear predict

training effects. Results from further analyses will be presented at the con-

ference. Conclusions: Early findings suggest that lower functioning older

adults demonstrate the greatest, durable effects of cognitive training across

a 12-month period. This finding may better assist in recognizing individuals

who might best gain from cognitive training interventions.

P2-357 EVENING CORTISOL IS ASSOCIATEDWITH

INTRA-INDIVIDUAL INSTABILITY IN DAYTIME

NAPPING IN NURSING HOME RESIDENTS WITH

DEMENTIA: AN ALLOSTATIC LOAD

PERSPECTIVE

Lynn Woods, Maria Yefimova, University of California, Los Angeles, Los

Angeles, California, United States.

Background: Circadian rhythm disruption, alterations in sleep wake activ-

ity and daytime napping is consistently reported in NH residents with de-

mentia. Linked to a life cycle model of chronic stress, the concept of

allostatic load may provide a lens to view sleep wake alterations and nap-

ping activity in NH residents with dementia. Normally, within individual

sleep-wake and daytime napping activity are relatively stable, while day-

to-day instability is an indication of a circadian rhythm disruption. The pur-

pose of this study was to examine the association between intra-individual

daytime napping episodes, as a measure of allostatic load, and basal cortisol

diurnal rhythm in NH residents with dementia Methods: Data from two

studies reported elsewhere were merged into a single data set for analy-

sis. In this within-individual longitudinal designed study of NH residents

[38 females and 13 males, aged 72-102 (mean 86.47)], with moderate to

severe dementia (N ¼ 51), we observed and recorded daytime napping

(sleep-wake state) every 20 minutes for 10 hr per day from 8:00 AM -

6:00 PM for 4 days. We obtained saliva samples to determine cortisol di-

urnal rhythm 4 times daily (wake time, within 60 minutes of waking, 6

hours after waking, 12 hours after waking) for 4 days. Results: Partici-

pants were categorized as high changers (HCs), those with day-to-day in-

stability, or low changers (LCs), those with day-to-day stability of napping

episodes. There was a significant difference between HC and LC in